Chronic pain: relief without drug risks.(Health)

Growing concern about the side effects of virtually all pain relievers has left people wondering if there's any way to safely control their pain.

The largest group of analgesics--including ibuprofen (Advil, Motrin) and other nonsteroidal anti-inflammatory drugs--may increase the likelihood of heart attack, stroke, and gastrointestinal bleeding. Even acetaminophen (Panadol, Tylenol) can cause liver damage if used improperly (see Drug Wise, below right).

The benefits of those drugs still outweigh the risks for most people, particularly when they're used as directed. But research suggests that several generally safer options offer significant pain relief compared with either standard therapy or a control, such as sham acupuncture.

None of the options listed here is clearly superior overall. The strongest predictor of how you'll respond may simply be whether you have confidence in the treatment. If one or two methods don't work, consider multifaceted approach, which may include medication.

Acupuncture. This treatment relieves pain and boosts function in osteoarthritic knees, a large clinical trial funded by the government has found. Other trials show that acupuncture can ease chronic back pain. In theory the needles work mainly by stimulating the release of pain-cutting endorphins.

Counseling/relaxation. A type of therapy called cognitive-behavioral can help you change negative attitudes about pain that can worsen the suffering and eliminate self-defeating behaviors that needlessly limit your activity. Meditation and other relaxation methods seem to work by easing muscle-tightening stress that contributes to pain. Biofeedback can teach you to reduce your negative reactions to the pain.

Exercise. Supervised, individualized stretching and strengthening regimens can relieve chronic low-back pain better than standardized group exercise programs. Yoga, which combines exercise, stretching, and relaxation, may help, too.